Strategy Call Request Form

Requirements:

You must be serious about your goals and ready for real change.

You must be ready to invest in a 4-12 week program that is not covered by insurance. This is a long term solution not a quick fix

Due to the personalized nature of how I work with clients, I'll review your responses to ensure the program is a perfect fit for you.

This is designed for those who are committed to uncovering the root cause of their chronic health symptoms and are prepared to invest in themselves to achieve the answers and results they desire.

Please fill out the form below and I will get back to you to schedule your free strategy call!

This is the first step in taking action to take back control of your health and life. It's time you finally get the answers and root cause you need to heal and see lasting results.

This is for ACTION TAKERS who are ready to get started!

First Name *

Last Name *

Phone *

Email *

Instagram handle (ex: @drcleoamelia) *

How would you like to be contacted? *

Please specify the dates and time frames (including what time zone you are in) that you are available for a 45-60 minute call so that I can offer you the best option that would work with your schedule *

What are your main complaints in regards to your health? *

What have you tried in the past to help with this? *

Describe how you want to feel in your body and in your life *

Do you feel there are any roadblocks getting in the way of you achieving these goals? *

Taking action to get real answers and lasting results is a big step, and it requires being ready to invest in your health. Working with me one-on-one INCLUDES the in-depth lab testing, personalized plans, and full support to help you reach your goals and transform your life. This is a 4-figure investment. Where do you currently stand when it comes to committing to your health and taking the next step? *

I’m ready to invest and get started right away but have a limited budget. I know the value of finally getting answers and results so I am willing to get creative with payment plan options.

I’m ready to invest and have some flexibility with my budget. I know investing in my health is key to achieving my goalsn 2

I’m ALL IN. I’m ready to invest in the exact solution that will get me the answers and results I’ve been searching for.

I know I need help but I’m not sure what’s next. I’m open to chatting more about what this could look like for me.

This is not within my budget and I would like to explore another option.

What level of support are you looking to invest in? *

I’m looking to jump start my health journey and get rid of my chronic symptoms through root cause lab testing and an individualized strategy that I can implement on my own. I do not need continued support along the way

I want a higher level accelerated program that will identify and address the root cause of my health issues through in depth lab testing and 1-on-1 guidance in a tailored program with personalized care and support along the way

I need a longer term exclusive concierge program. I’m ready to go all in for a complete transformation of my health and I am looking for a program that combines root cause lab testing, a personalized roadmap, personalized care, and 1-on-1 guidance in a time frame that offers more space and support.

Honestly, I am not sure what I need and would like to walk through the best option for me

Are you prepared to make an investment in your health NOW or is this something you are looking to start later on? *

Yes, if I feel you can help me

No, I am not ready to get started right now

Is there anybody else who will be part of the decision making process? (If so, id love to have them on the call so they can hear about the program as well!)

A zoom meeting room link will be provided to you upon booking for you to join at the time of our call. *

Yes, I understand this is not a phone call but is a zoom call. I will be in a quiet place with no distractions ready to focus and dive in

By checking this box, I double checked that my contact information and responses are correct and complete. I also understand that if I "no show" my scheduled call or do not communicate within 24 hours of the call to reschedule/cancel, my call will NOT be rescheduled. *

Yes I agree and double checked my information is correct

How did you hear about Cleo Amelia Wellness? *

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